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Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study
Bursics A, Morvay K, Kupcsulik P, Flautner L. (March 2004) International Journal of Colorectal Disease, 19(2), 176-180.
BACKGROUND AND AIMS: Doppler-guided hemorrhoid artery ligation is a new approach for treating hemorrhoids. Early and 1-year follow-up results of the procedure are presented and compared with those of closed scissors hemorrhoidectomy in a prospective randomized study.
PATIENTS AND METHODS: Sixty consecutively recruited patients were randomized into two groups: group A ( n=30) was treated with standardized closed scissors hemorrhoidectomy and group B ( n=30) with Doppler-guided hemorrhoid artery ligation. The follow-up period was 11.7+/-4.6 months.
RESULTS: The average need for minor analgesics was 11.7+/-12.6 doses in group A and 2.9+/-7.7 in group B. Patients in group A spent 62.9+/-29.0 hours in hospital postoperatively and those in group B 19.8+/-41.8 hours. Return to normal daily activities took 24.9+/-24.5 days in group A and 3.0+/-5.5 days in group B. Neither the disappearance (26 vs. 25 patients) nor the recurrence of preoperative symptoms (5 vs. 6 patients) differed significantly between the two groups.
CONCLUSION: Both procedures were effective in treating hemorrhoids. The 1-year results of Doppler-guided hemorrhoid artery ligation do not differ from those of closed scissors hemorrhoidectomy. Doppler-guided hemorrhoid artery ligation seems to be ideal for 1-day surgery, and it fulfills the requirements of minimally invasive surgery.
Ambulatory haemorrhoid therapy
[Article in German]
Muller-Lobeck H. (2001) Chirurg, 72(6), 667-676.
For thousands of years, anal complaints were treated symptomatically with ointments, suppositories and, in isolated cases, even surgically. Since the middle of the last century injection sclerotherapy has been by far the most widespread out-patient treatment for the very common haemorrhoidal disease. This is based on the notion that haemorrhoids are varicosities, and while this idea has been contested by the theory of a spongy body for over 200 years, it is nonetheless only in the last 40 years that the spongy body theory has become accepted, giving rise to further important functional investigations on the anal structures involved in bowel continence and to rational treatment for haemorrhoids. The conditions necessary for out-patient treatment of haemorrhoids and the options available are presented in this paper and discussed with reference to acceptance, inherent risks, and the possible complications. While diet and behavioural methods, and also anal dilatation and treatment with ointments, can be managed by the patient without any problems, regardless of how effective sclerotherapy and rubber band ligation are, these involve risks whose ramifications are often underestimated. One operative procedure that may well become established as an effective out-patient method in the future is Doppler-guided isolated haemorrhoidal artery ligation (HAL) after Morinaga. Traditionally, day surgery is not so well accepted for haemorrhoidectomy in Germany; unless the operation planned is not very extensive, in-patient treatment is still considered preferable.
A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter
Morinaga K., et al. (1995) The American Journal of Gastroenterology, 90(4), 610-613.
OBJECTIVES: To assess the usefulness of hemorrhoidal artery ligation (HAL) for internal hemorrhoids with a newly devised instrument (the Moricorn).
METHODS: We devised a new instrument (the Moricorn) that is used in conjunction with a Doppler flowmeter. This instrument allows for easy and safe ligation of the hemorrhoidal artery. HAL with the Moricorn was performed on 116 patients with internal hemorrhoids who had episodes of anal pain, bleeding, and prolapse. One month after treatment, the effect was evaluated on the basis of improvement of symptoms and the shrinkage of hemorrhoidal tissue.
RESULTS: The treatment’s effect was observed in 50 of 52 patients (96%) with pain, 50 of 64 (78%) with prolapse, and 92 of 96 (95%) with bleeding. No patient required anesthesia throughout the entire procedure. No major complications were encountered with this treatment.
CONCLUSIONS: HAL with the Moricorn is a simple, safe, and effective method. However, further observations predicated on a longer follow-up, a larger number of patients, and comparisons with other conventional treatments are called for.
The Surgical Management of Haemorrhoids – A Review
A. Hardy, C.L.H. Chan, C.R.G. Cohen. (2005) Digestive Surgery, 22(1-2), 26-33.
A number of new surgical treatments have led to a reappraisal of haemorrhoid disease over the last few decades. Despite a range of treatment modalities, the options are limited in thier effectiveness and can lead to a number of complications. An inadequate classification system based on appearance rather than symptoms makes the choice of appropirate therapy difficult. More recent techniques have led to a move away from surgical excision. However, furthre research is required to establish their precise indications and long-term efficacy.
NICE, The National Institute for Health and Clinical Evidence, has released an article making recommendations about the safety and efficacy of an interventional procedure, such as the HAL-RAR Procedure for haemorrhoids.
List of Resources
- HAL-RAR Video Animation
- Clinical Publications
- Medical Reports on HAL-RAR
- NICE recommendations & HAL-RAR
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